Eyelid Condition

Question 1

Eyelid Anatomy

Answer 1

III. Glands of the Eyelid (post to ant)

Question 2

III. Glands of the Eyelid (post to ant)

Answer 2

A. accessory lacrimal glands (of Krause and Wolfring)
B. Meibomian glands
C. Glands of Zeis
D. Glands of Moll

Question 3

A. accessory lacrimal glands (of Krause and Wolfring)

Answer 3

1.  Beneath the palpebral conjunctiva, superiorly
2.  Produces tears to provide moisture for conjunctival sac and
cornea

Question 4

B. Meibomian glands

Answer 4

1.  Sebacious glands in the tarsal plate
2.  Do not communicate with hair follicles
3.  Produce a sebacious secretion which creates an oily layer
on the surface of the tear film (slows evaporation of tears)

Question 5

C. Glands of Zeis

Answer 5

1.  Small modified sebaceous glands connected

with the hair follicles of the eyelashes

Question 6

D. Glands of Moll

Answer 6

1.   Sweat glands tubular not a glomerulus

2.   Located anterior to the eyelashes

Question 7

III. Eye lid - Exogenous Infections

Answer 7

A.  Blepharitis

B.  Meibomianitis

Question 8

A.  Blepharitis

Answer 8

1.  common condition that causes inflammation of the
eyelids.
2.  Types
a.  Anterior
1)  Staphylococcal - affects the outside front of the eyelid,
where the eyelashes are attached.
b.  Seborrheic
1)  Seborrheic dermatitis is a papulosquamous disorder
found on sebum rich areas of scalp, face & trunk.
2)  Often involves the eyelid margin

1.  common condition that causes inflammation of the
eyelids.
2.  Types
a.  Anterior
b.  Seborrheic
c.  Posterior
1)  Meibomianitis – blockage of Meibomian gland leading
to a chalazion
3.  Treatment
a.  Warm compresses
b.  Wash eyelid with Johnson’s Baby Shampoo
c.  Traction closed lid laterally, gently rub along eyelid margin
medially to laterally to express gland contents

Question 9

Infection and Inflammation of Lids

Answer 9

I.  Anterior Blepharitis - Hordeolum

Question 10

I.  Anterior Blepharitis - Hordeolum

Answer 10

A.  Staph infection of the lid glands

Question 11

A.  Staph infection of the lid glands

Answer 11

1.  Localized red, swollen, and tender area
a.  Actually an abscess with pus formation in the lumen of
the affected gland
1)  Meibomian gland involved - the abscess is relatively
large and called an internal hordeolum
2)  Glands of Moll or Zeis involved - the abscess is
small and more superficial and called external
hordeolum (sty)
b.  Pain is the primary symptom, directly related to the
amount of swelling.
c.  Internal hordeolum can point to the skin or to the
conjunctiva; external hordeolum always points to the
skin

Question 12

Infection and Inflammation of Lids

Answer 12

I.  Hordeolum

II. Chalazion

Question 13

I.  Hordeolum

Answer 13

B.  Treatment
A.  Warm compress 10-15 min 3-4/day
B.  If does not resolve in 48 hrs, incision and
drainage of pus
C.  Optic antibiotic ointment instilled in conjunctival
sac q3hr

Question 14

II. Chalazion

Answer 14

A.  A sterile granulomatous inflammation of a
meibomian gland characterized by painless
swelling of upper or lower lid.
1.  Majority of these will point to the conjunctival
side.
2.  See reddened and swollen area on lid eversion
3.  If large enough, chalazion will push on the
eyeball and cause astigmatism
4.  Differentiated from internal hordeolum by
absence of acute signs of inflammation.
5.  Sx excision usually necessary (vertical incision)
6.  If recurrent should be biopsied to r/o malignancy

Question 15

Ectropion

Answer 15

I.  Senile Ectropion

Question 16

I.  Senile Ectropion

Answer 16

A.  Loss of tone and laxity of orbicularis muscle

Question 17

A.  Loss of tone and laxity of orbicularis muscle

Answer 17

1.  Lower lid margin falls away from the globe with
eversion of the punctum (tear duct) resulting in
epiphora.
2.  Pt constantly wipes eye irritating the lower lid
3.  Conjunctiva and everted lid margin become irritated
and thickened
4.  Rx: Sx shortening of lower lid and lateral
displacement of the overlying skin

Question 18

Paralytic Ectropion

Answer 18

I.  Characterized by loss of tone in

orbicularis muscle with facial paralysis

Question 19

I.  Characterized by loss of tone in

orbicularis muscle with facial paralysis

Answer 19

A.  Symptoms are paresis of orbicularis,
incomplete closure of eyes, and
overactivation of the levator and Muller’
s
muscle

Question 20

A.  Symptoms are paresis of orbicularis,
incomplete closure of eyes, and
overactivation of the levator and Muller’
s
muscle

Answer 20

1.  Results are widening of the lid fissure, slight
proptosis, exposure of sclera above and below
the cornea, and staring expression
2.  Loss of lower lid tone, eversion of the lower
punctum and poor tear drainage
3.  Tear secretion is decreased with a lesion in VII
between pons and geniculate ganglion

Question 21

Paralytic ectotropion

Answer 21

Widening of the lid 
fussure in peripheral 
right facial nn paralysis. 
Entire facial paralysis 68 
YOF

Question 22

Entropion

Answer 22

I.  Spastic or senile

Question 23

I.  Spastic or senile

Answer 23

A.  Age dependent increase in orbicularis

tone

Question 24

A.  Age dependent increase in orbicularis

tone

Answer 24

1.  On opening the eyes these fibers do not
relax sufficiently
a.  Predisposing factors: laxity of the skin of lids,
chronic inflammation of conjunctiva or lid margins,
intraocular inflammation,
b.  Physical findings: turning in of lower lid with
misdirection of lashes (pseudotrichiasis)
1)  Lashes scrape on the cornea
2)  A viscious cycle may develop due to
blepharospasm with danger of corneal erosion
and ulceration
3)  Rx inflammation. Tape to pull lid away from
the globe. Sx to tighten skin of lower lid and
remove orbicularis fibers near the lid